1225082878 NPI number — SAINT JOSEPH REGIONAL MEDICAL CENTER, INC.

Table of content: (NPI 1225082878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225082878 NPI number — SAINT JOSEPH REGIONAL MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT JOSEPH REGIONAL MEDICAL CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAINT JOSEPH PHYSICIAN NETWORK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225082878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 CEDAR ST STE 200
Provider Second Line Business Mailing Address:
SJHS PROVIDER SERVICES
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46617-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-335-8700
Provider Business Mailing Address Fax Number:
574-335-0741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2349 LAKE AVE STE 99
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46563-7837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-948-5340
Provider Business Practice Location Address Fax Number:
574-948-5494
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
574-335-4654

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 021236800 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 300000756 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300041953 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300046029 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300048902 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ6650 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200162760B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200162760G , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300026356 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300028778 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000358580 . This is a "BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200162760C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300038977 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300046084 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300035855 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300047494 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200162760A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300020807 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300055981 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300000759 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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